Copper-Catalyzed Bromo-cyanomethylative Cyclization of Enynes.

A copper-catalyzed bromo-cyanomethylative cyclization of 1,6-enynes is demonstrated. The treatment of 2-bromoacetonitrile with CuI enables the alkyl radical generation and triggers the radical addition/cyclization/bromination sequence, giving various vinyl C-Br bonds containing functionalized heterocycles in good yields.

Advancing the Boundary of Pre-trained Models for Drug Discovery: Interpretable Fine-Tuning Empowered by Molecular Physicochemical Properties.

In the field of drug discovery, a proliferation of pre-trained models has surfaced, exhibiting exceptional performance across a variety of tasks. However, the extensive size of these models, coupled with the limited interpretative capabilities of current fine-tuning methods, impedes the integration of pre-trained models into the drug discovery process. This paper pushes the boundaries of pre-trained models in drug discovery by designing a novel fine-tuning paradigm known as the Head Feature Parallel Adapter (HFPA), which is highly interpretable, high-performing, and has fewer parameters than other widely used methods. Specifically, this approach enables the model to consider diverse information across representation subspaces concurrently by strategically using Adapters, which can operate directly within the model's feature space. Our tactic freezes the backbone model and forces various small-size Adapters' corresponding subspaces to focus on exploring different atomic and chemical bond knowledge, thus maintaining a small number of trainable parameters and enhancing the interpretability of the model. Moreover, we furnish a comprehensive interpretability analysis, imparting valuable insights into the chemical area. HFPA outperforms over seven physiology and toxicity tasks and achieves state-of-the-art results in three physical chemistry tasks. We also test ten additional molecular datasets, demonstrating the robustness and broad applicability of HFPA.

Genetic Testing Technology Assisting in the Diagnosis and Treatment of Multiple Suppurative Arthritis and Extensive Migratory Skin and Soft Tissue Infections Caused by Disseminated Staphylococcus aureus Disease: A Case Report and Review.

Staphylococcus aureus (S. aureus) infection is readily disseminated, yet the multiple septic arthritis and extensive migratory skin and soft tissue infections it causes are uncommon and challenging to treat. The infection can be life-threatening, with a mortality rate of 15-31%. Early, targeted antibiotic therapy is critical to improve prognosis. However, routine cultures are time-consuming and have low positivity rates, which may lead to errors in antibiotic regimen selection, depriving patients of optimal treatment. Genetic testing technologies, such as macrogenomic next-generation sequencing (mNGS) and digital polymerase chain reaction (dPCR), are now emerging as powerful tools for early pathogen diagnosis as well as pathogen diagnosis of target detectors with low microbial loads. In this study, we report a 53-year-old man who was admitted to the ICU for treatment of septic shock. The causative agent was targeted earlier as S. aureus by mNGS, and the shock was corrected more quickly with targeted antibiotic medication. However, he later developed multiple septic arthritis and an extensive migratory skin soft tissue infection with persistent fever, and at one point a gram-negative bacterial infection was suspected, and the antibiotic regimen was incorrectly changed. Blood dPCR suggested that the causative organism was still methicillin-sensitive S. aureus (MSSA), with no drug resistance gene detected, and the anti-infective regimen was readjusted, and the patient eventually recovered and was discharged from the hospital. We present this rare case and review related studies to validate the superiority of genetic testing technology in pathogen diagnosis, which deserves further application.

DCDiff: Dual-Granularity Cooperative Diffusion Models for Pathology Image Analysis.

Whole Slide Images (WSIs) are paramount in the medical field, with extensive applications in disease diagnosis and treatment. Recently, many deep-learning methods have been used to classify WSIs. However, these methods are inadequate for accurately analyzing WSIs as they treat regions in WSIs as isolated entities and ignore contextual information. To address this challenge, we propose a novel Dual-Granularity Cooperative Diffusion Model (DCDiff) for the precise classification of WSIs. Specifically, we first design a cooperative forward and reverse diffusion strategy, utilizing fine-granularity and coarse-granularity to regulate each diffusion step and gradually improve context awareness. To exchange information between granularities, we propose a coupled U-Net for dual-granularity denoising, which efficiently integrates dual-granularity consistency information using the designed Fine- and Coarse-granularity Cooperative Aware (FCCA) model. Ultimately, the cooperative diffusion features extracted by DCDiff can achieve cross-sample perception from the reconstructed distribution of training samples. Experiments on three public WSI datasets show that the proposed method can achieve superior performance over state-of-the-art methods. The code is available at https://github.com/hemo0826/DCDiff.

An innovative and convenient technique to reduce anastomotic leakage after double stapling anastomosis: laparoscopic demucositized suture the overlapping point of the "dog ear" area.

Anastomotic leakage (AL) is a major cause of postoperative morbidity and mortality in the treatment of colorectal cancer. The aim of this study was to investigate an innovative and convenient technique of laparoscopic demucositized suture the overlapping point of the "dog ear" area after the double stapling anastomosis (lds-DSA), as an improved alternative for conventional DSA, and whether it could reduce the AL rate in laparoscopic anterior resection (Lapa-AR). Between January 2018 and December 2020, a total of 245 patients who underwent Lapa-AR for the treatment of adenocarcinoma of the sigmoid colon or rectal cancer were divided into the lsd-DSA group (n = 99) and the DSA group (n = 146). Data were analyzed retrospectively. Morbidity, AL rate and other perioperative outcomes were compared between the two groups. Patient demographics, preoperative comorbidity, preoperative chemoradiotherapy, tumor size, stage, and other operative details were comparable between the two groups. There was no difference in surgical time between the two groups (196.41 ± 76.71 vs. 182.39 ± 49.10 min, p = 0.088). The overall complication rate was also without a difference (11/99, 11.11% vs. 21/146, 14.38%, p = 0.456), but AL rate significantly lower in the lsd-DSA group than in the DSA group (2/99, 2.02% vs. 12/146, 8.22%, p = 0.040). For other perioperative outcomes, the lsd-DSA group shortened the total and postoperative hospital stay, and the time to pull out drainage tube than in the DSA group. Our comparative study demonstrates lds-DSA to have a better short-term outcome in reducing AL compared with DSA. This technique could be an alternative approach to maximize the patients' benefit in Lapa-AR.

Regional lymph nodes distribution pattern in central area of right-sided colon cancer: in-vivo detection and the update on the clinical exploration.

Distribution of regional lymph nodes (LNs) is decisive for the lymphadenectomy boundary in radical resection of right-sided colon cancer (RCC). Currently, the data of LNs in central area remains ambiguous and scarce. Herein we aim to provide a more detailed anatomical research on LNs surrounding the superior mesenteric vessels for RCC and investigated the metastasis rate. In this study, Carbon Nanoparticles (CNs) and Indocyanine Green (ICG) were used for regional LNs mapping by preoperative colonoscopic tattooing (PCT) and we laparoscopically observed the stained LNs distribution pattern. Lastly, 143 RCC patients who received a "superior mesenteric artery (SMA)-oriented" hemicolectomy were included to calculate the probability of LNs metastasis in our target area. 27 patients diagnosed as RCC (mean age 58.04 years, 17 male) were included. 14 patients underwent CNs injection and 13 patients consented to the ICG, while 4 cases suffered from imaging failure. The unequal number of the regional LNs located between SMV and SMA was detected in 22 cases (81.48%), posterior to SMV area in 6 cases (22.22%), and anterior to SMA in 16 cases (59.26%), respectively. The presence of LNs posterior to SMV was associated with the crossing pattern of ileocolic artery (χ2 = 4.24, P = 0.039). The probability of LNs metastasis in the above areas (target areas) was 2.10% (3/143). In conclusion, right-hemi colon-draining lymphatic vessels anteriorly/posteriorly traversed the SMV and arrived at the surface of SMA near the middle colonic artery (MCA) level, which highlights the potential need of removing mesenteric tissue in our target area on lymphatic resection.

Superhydrophobic Methylated Silica Sol for Effective Oil-Water Separation.

Superhydrophobic methylated silica with a core-shell structure was successfully fabricated by a sol-gel process. First, a pristine silica gel with an average particle size of ca. 110 nm was prepared, using tetraethylorthosilicate (TEOS) as a precursor, ethanol as a solvent, and NH4OH as a catalyst. Then, the superhydrophobic methylated silica sol was prepared by introducing methyltrimethoxysilane (MTMS), to graft the surface of the pristine silica gel with methyl groups. The structure and morphology of the methylated silica sol were characterized by Fourier transform infrared (FTIR) spectroscopy, field emission scanning electron microscopy (FE-SEM), and transmission electron microscope (TEM). The characterization results showed that methyl groups were successfully grafted onto the surface of the pristine silica, and the diameter of the methylated silica was increased by 5-10 nm. Various superhydrophobic surfaces on glass, polyethylene terephthalate (PET) fabric, cotton, open-cell polyurethane (PU) foam, and polypropylene (PP) filter cloth were successfully constructed by coating the above substrates with the methylated silica sol and reached with a maximum static water contact angle and slide angle of 161° and 3°, respectively. In particular, the superhydrophobic PP filter cloth exhibited promising application in oil-water separation. The separation efficiency of different oil-water mixtures was higher than 96% and could be repeated at least 15 times.

[Criminal fold priority separating reduces splenic injury in laparoscopic radical gastrectomy].

OBJECTIVE: To explore the value of criminal fold priority separating (CFPS) in reduction of iatrogenic splenic injury in laparoscopic radical gastrectomy. METHODS: Complete videos of 270 patients undergoing laparoscopic radical gastrectomy in Guangdong Provincial Hospital of Chinese Medicine were reviewed. Anatomic features of criminal fold (CF) were summarized. The relationship between CFPS and iatrogenic splenic injury was examined. CF was defined as the ligament between omentum and spleen. CFPS was defined as that CF was separated before the left half gastrocolic omentum was dissected. Splenic injury was further compared between CFPS group and non-CFPS group. RESULTS: CF occurred in 81.5% cases (220/270), presenting one bunch or multiple bunches. CF appeared most commonly in the lower pole of spleen (76.7%, 207/270), then in middle spleen (14.1%, 38/270) and upper pole (9.6%, 26/270). CFPS was performed in 20% cases (54/270) and 80% cases (216/270) were non-CFPS. The incidence of iatrogenic splenic injury was 11.1% (30/270), and this incidence of CFPS group was lower as compared to non-CFPS group (3.7%, 2/54 vs. 13.0%, 28/216), but the difference was not significant (P=0.07). Of 30 patients with splenic injury, 24(80%) were due to traction of CF and all were in non-CFPS group. Instrument injury occurred in 20% cases(6/30) and 2 were in CFPS group and 4 were in non-CFPS group. Most iatrogenic splenic injuries were successfully handled with electrocoagulation, adhesive and compression, except 2 patients underwent open splenectomy for serious splenic injury in non-CFPS group. CONCLUSION: In laparoscopic surgery for gastric cancer, iatrogenic splenic injury mostly results from improper traction of CF and CFPS can reduce the incidence of iatrogenic splenic injury.